A dataset for soil organic carbon in agricultural systems for the Southeast Asia region.

The determination of changes in soil organic carbon (SOC) content under different cropping systems is necessary for policy development oriented towards soil conservation, C sequestration, and future C credit markets. The aim of this study was to generate an open SOC dataset resulting from a systematic literature search related to the agricultural systems for Southeast Asia. The dataset has 209 articles and 4341 observations on soils of cropping systems in this region from articles published between 1987 and 2023. This dataset included different management practices, land uses, soil sampling depth, and length of SOC content assessment. In addition, inherent features of crop production reported in the experiments were included in the dataset. This dataset can be applied to quantify and compare the impact of different land uses or management practices on SOC content, providing foundational knowledge towards identifying sustainable practices. Lastly, it is a useful guide for future regional SOC sequestration policies and the development of C credit markets.

First Report of Golovinomyces bolayi Causing Powdery Mildew on Lettuce in Mexico.

In August 2022, powdery mildew symptoms were detected on lettuce (Lactuca sativa) in a commercial field located in Quecholac, Puebla, Mexico. Signs appeared as whitish powdery masses on leaves. Disease incidence was about 100% and signs covered up to 40% of leaf surface. Mycelium was amphigenous forming white patches. Hyphal appressoria were indistinct or nipple-shaped and solitary. Conidiophores (n= 30) were hyaline, erect, arising from the upper surface of hyphal mother cells or lateral, and of 90 to 201 µm long. Foot cells were cylindrical, of 49 to 92 × 10-15 µm, followed by 1-3 shorter cells, and forming conidia in chains. Conidia (n= 100) were hyaline, ellipsoid-ovoid, doliiform-subcylindrical, 27 to 40 × 14 to 20 µm. Conidial germination belonging to the Euoidium type. Chasmothecia were not observed. The morphological characters were consistent with those of Golovinomyces bolayi (Braun et al. 2019). A voucher specimen was deposited in the Herbarium of the Department of Agricultural Parasitology at the Chapingo Autonomous University under accession number UACH451. To confirm the identification of the fungus, genomic DNA was extracted from conidia and mycelium following the CTAB method (Doyle and Doyle 1990), and the internal transcribed spacer (ITS) region was amplified by PCR using the primers ITS5/ITS4 (White et al. 1990) and sequenced. The resulting 506 bp sequence had 100% identity to those of G. bolayi (LC417109 and LC417106). Phylogenetic analyses using the Maximum Likelihood and Maximum Parsimony methods were performed and confirmed the results obtained in the morphological analysis. The isolate UACH451 grouped in a clade with isolates of G. bolayi. The ITS sequence was deposited in GenBank under accession number OR467546. Pathogenicity was confirmed by gently dusting conidia onto ten leaves of healthy lettuce plants. Five non-inoculated leaves served as controls. The plants were maintained in a greenhouse at 25 to 30 ºC, and relative humidity of 70%. All inoculated leaves developed similar symptoms to the original observation after 10 days, whereas control leaves remained disease free. Microscopic examination of the fungus on inoculated leaves showed that it was morphologically identical to that originally observed. Based on morphological data and phylogenetic analysis, the fungus was identified as G. bolayi. This pathogen has been previously reported causing powdery mildew on lettuce in Argentina, Canada, Chile, Ecuador, Peru, USA and Venezuela (Braun et al. 2019; Mieslerová et al. 2020). To our knowledge, this is the first report of G. bolayi causing powdery mildew on lettuce in Mexico.

Comparison of Corticotomy and Micro-osteoperforation during Canine Retraction: A Split-Mouth Design.

OBJECTIVE: Compare the efficacy of the micro-osteoperforation (MOP) and corticotomy techniques in terms of maxillary canine retraction. METHODS: Thirteen patients (5 females, 8 males; mean age, 18.07 ± 6.74 years) with healthy permanent dentition and requiring the extraction of maxillary first premolars were included in a split-mouth randomized clinical trial. Those subjects with previous orthodontic or endodontic treatment of the canines were excluded. At least 3 months post-extraction, MOPs and corticotomies were performed distal to the canines. Mini-screws with closed-coil springs (150 g) were used for the canine retraction. Dental casts were made at baseline (T0) and 3 months post-intervention (T1). Trained and calibrated examiners measured the distances from the canines to the second premolars on both sides. A signed-rank sum test was used to compare the amount of canine retraction achieved in 3 months (T0-T1) on the 2 sides. RESULTS: Retraction (mm) at the incisal level was similar in the corticotomy (3.34 ± 1.01) and MOP patients (2.74 ± 1.10) (P = 0.11); furthermore, there were no differences in the degree of medial retraction between the corticotomy (2.56 ± 0.67) and MOP (2.27 ± 0.82) (P = 0.31) procedures. No adverse events were observed. CONCLUSION: There were not any clinically or statistically significant differences in retraction between the interventions. At 3 months, a MOP is as effective as a corticotomy in accelerating the rate of tooth movement.

First Report of White Mold Caused by Sclerotinia sclerotiorum on Brussels Sprouts in Mexico.

The Brussels sprout (Brassica oleracea var. gemmifera) is a cruciferous vegetable with high health-promoting value and Mexico is one of the most valuable exporters worldwide (Data Mexico 2023). From September to November 2021, white mold symptoms (Rimmer et al. 2007) were observed in Brussels sprouts (cv. Confidant) fields in Tonatico, Estado de México, Mexico. Irregular, necrotic lesions were observed on leaves, whereas abundant white mycelium, and later black sclerotia were produced outside and inside of stems. Disease incidence ranged from 20 to 40% in five fields. For fungal isolation, symptomatic stem pieces were surface sterilized with 2% sodium hypochlorite for 2 min, rinsed in sterilized distilled water twice, placed on PDA medium, and incubated at 25°C in darkness for 3 days. Sclerotinia-like colonies were consistently obtained and six isolates were purified by the hyphal-tip method. Fungal colonies were white and fluffy. Irregular, black, and small (3 to 6 mm diameter) sclerotia were produced at the edge of colonies after 5 days of incubation. The morphological characters were consistent with those of Sclerotinia sclerotiorum (Saharan and Mehta 2008). Two representative isolates were selected for molecular analysis and pathogenicity tests. The isolates were deposited in the Culture Collection of Phytopathogenic Fungi at the Colegio Superior Agropecuario del Estado de Guerrero under the accession numbers CSAEG50 and CSAEG51. For molecular identification, genomic DNA was extracted, and the internal transcribed spacer (ITS) region was amplified by PCR and sequenced using the primer pair ITS5/ITS4 (White et al. 1990). The sequences were deposited in GenBank (accession nos. OQ878510 and OQ878511). BLASTn searches in GenBank showed 100% identity with the available sequences of Sclerotinia sclerotiorum (accession nos. OQ891471, OQ891472, HQ833448, and MT177216). A phylogenetic analysis using the Maximum Likelihood method placed isolates CSAEG50 and CSAEG51 in the same clade as S. sclerotiorum. Pathogenicity tests were performed by inoculating 10 healthy Brussels sprout seedlings (cv. Confidant) grown in pots. A mycelial plug was directly placed on the stem of each plant. Five uninoculated Brussels sprout seedlings were used as control. All plants were placed in a moist chamber at 25°C with a 12-h photoperiod for 2 days. White mold symptoms appeared on inoculated plants after 3 days, whereas control plants remained symptomless. The fungi were reisolated from the infected plants and found to be morphologically identical to the isolates used for inoculation, fulfilling Koch's postulates. Pathogenicity test was performed twice with similar results. Sclerotinia sclerotiorum has been previously reported to infect Brussels sprouts in the USA (Campbell 1947). To our knowledge, this is the first report of Sclerotinia sclerotiorum causing white mold of Brussels sprouts in Mexico. The disease is widely distributed in Brussels sprouts fields in the central region of Mexico, therefore additional studies are needed to develop effective disease-management strategies.

Experiencia académica sobre la presentación de trabajos científicos en la IV Conferencia Internacional: Desafíos clínicos y terapéuticos en psicosis / Academic experience on the presentation of scientific papers at the IV International Conference: Clinical and therapeutic challenges in psychosis

Dentro de los desafíos de la investigación en psicosis en Chile y el mundo se encuentra el desarrollo de polos académicos de investigación en estados mentales de riesgo (EMARS). En este artículo se realiza un análisis descriptivo de los trabajos científicos presentados en la IV conferencia internacional: Desafíos Clínicos y terapéuticos en Psicosis realizada en octubre del 2022. Métodos: Se realizó una selección y premiación del mejor trabajo de acuerdo a un sistema de puntuación realizado por un comité científico ad-hoc. Luego se sistematizó la información en una tabla resumen para su posterior análisis descriptivo cualitativo. Resultados: Se seleccionaron 5 trabajos. El 100% de los trabajos seleccionados abordan el tema de la detección precoz e intervención temprana en psicosis, en particular en la temática EMARS. Asimismo, la mayoría de los trabajos presentados provienen de la región metropolitana. El 80% de los trabajos realizan un diseño experimental con reclutamiento de pacientes y el 20% usaron una metodología cualitativa. Conclusión: Así como años anteriores, los trabajos seleccionados dan cuenta de la importancia por el mejoramiento en la prevención, diagnóstico e intervención temprana en Psicosis. Se debe potenciar en Chile y latinoamerica el desarrollo académico y clínico en el campo de los EMARS.

Among the challenges of research in psychosis in Chile and the world, is the development of academic hubs for research in at-risk mental states (ARMS). This article presents a descriptive analysis of the summaries of the scientific works presented at the IV international conference: Clinical and Therapeutic Challenges in Psychosis held in October 2022. Methods: A selection and award were made for the best work according to a scoring system developed by an ad-hoc scientific committee. Then the information was systematized in a summary table for its subsequent qualitative descriptive analysis. Results: 5 works were selected. 100% of the selected works address the issue of early detection and early intervention in psychosis, particularly in the ARMS. Most of the papers presented come from the metropolitan region. 80% of the works carried out an experimental design with patient recruitment and 20% used a qualitative methodology. Conclusion: As in previous years, the selected works show the importance of improving prevention, diagnosis, and early intervention in psychosis. Research and clinical work in Chile and Latinoamerica should be strengthened in the field of ARMS.

Surgical Salvage of Annular Rupture After Transcatheter Aortic Valve Implantation by Conversion Into Annular Enlargement.

We describe an 88-year-old woman who experienced annular rupture during transcatheter aortic valve replacement despite preventative measures. She underwent Y incision and rectangular patch for the double purpose of repairing the rupture and enlarging the aortic root. We highlight the heart team's role in confronting this potentially catastrophic complication. (Level of Difficulty: Advanced.).

IRE1α overexpression in malignant cells limits tumor progression by inducing an anti-cancer immune response.

IRE1α is one of the three ER transmembrane transducers of the Unfolded Protein Response (UPR) activated under endoplasmic reticulum (ER) stress. IRE1α activation has a dual role in cancer as it may be either pro- or anti-tumoral depending on the studied models. Here, we describe the discovery that exogenous expression of IRE1α, resulting in IRE1α auto-activation, did not affect cancer cell proliferation in vitro but resulted in a tumor-suppressive phenotype in syngeneic immunocompetent mice. We found that exogenous expression of IRE1α in murine colorectal and Lewis lung carcinoma cells impaired tumor growth when syngeneic tumor cells were subcutaneously implanted in immunocompetent mice but not in immunodeficient mice. Mechanistically, the in vivo tumor-suppressive effect of overexpressing IRE1α in tumor cells was associated with IRE1α RNAse activity driving both XBP1 mRNA splicing and regulated IRE1-dependent decay of RNA (RIDD). We showed that the tumor-suppressive phenotype upon IRE1α overexpression was characterized by the induction of apoptosis in tumor cells along with an enhanced adaptive anti-cancer immunosurveillance. Hence, our work indicates that IRE1α overexpression and/or activation in tumor cells can limit tumor growth in immunocompetent mice. This finding might point toward the need of adjusting the use of IRE1α inhibitors in cancer treatments based on the predominant outcome of the RNAse activity of IRE1α.

Tumoral microenvironment prevents de novo asparagine biosynthesis in B cell lymphoma, regardless of ASNS expression.

Depletion of circulating asparagine with l-asparaginase (ASNase) is a mainstay of leukemia treatment and is under investigation in many cancers. Expression levels of asparagine synthetase (ASNS), which catalyzes asparagine synthesis, were considered predictive of cancer cell sensitivity to ASNase treatment, a notion recently challenged. Using [U-13C5]-l-glutamine in vitro and in vivo in a mouse model of B cell lymphomas (BCLs), we demonstrated that supraphysiological or physiological concentrations of asparagine prevent de novo asparagine biosynthesis, regardless of ASNS expression levels. Overexpressing ASNS in ASNase-sensitive BCL was insufficient to confer resistance to ASNase treatment in vivo. Moreover, we showed that ASNase's glutaminase activity enables its maximal anticancer effect. Together, our results indicate that baseline ASNS expression (low or high) cannot dictate BCL dependence on de novo asparagine biosynthesis and predict BCL sensitivity to dual ASNase activity. Thus, except for ASNS-deficient cancer cells, ASNase's glutaminase activity should be considered in the clinic.

Responses of Soybean Genotypes to Different Nitrogen and Phosphorus Sources: Impacts on Yield Components, Seed Yield, and Seed Protein.

Soybean (Glycine max [L.] Merr) is an important crop, as both food for humans and feed for livestock in Cambodia, but the yields are low, due to use of low yielding genotypes and limited use of inputs. This study aimed to investigate the effects of different genotypes and different N and P fertilizer sources on growth, seed yield, and seed protein of soybean. Five genotypes (Sbung, Hongry, 98C81, ACS1, and Kaiabi) were grown under different N (90 kg N ha-1 from urea, nano-n, Nitroplus, and without N application as control) and P fertilizers (50 kg P ha-1 from Inorganic P, nano-p, Mykovam, and without P application as control) in two screenhouse experiments. Shoot, root, and nodulation traits, as well as seed yield and protein, were significantly affected by genotypes and different N and/or P fertilizer sources. Notably, while genotypes Sbung and 98C81 showed the highest yields among the genotypes, regardless of different N and P fertilizers, only Sbung had the highest seed protein. The application of different N and/or P sources significantly increased seed yield, compared to non-N and -P application. Specifically, seed yield and seed protein were higher when treated with nano-n or urea, and number of nodules, root biomass, and nodule dry weight was increased with Nitroplus, whereas seed yield and protein were higher with nano-p, Mykovam, and inorganic P. Application rate of 90 kg N ha-1 and 50 kg P ha-1 produced higher seed yield and its components and seed protein. We conclude that N and P application as well as Nitroplus inoculation can help increase seed yield of soybean in Cambodia.

Physiological impact of in vivo stable isotope tracing on cancer metabolism.

BACKGROUND: There is growing interest in the analysis of tumor metabolism to identify cancer-specific metabolic vulnerabilities and therapeutic targets. Finding of such candidate metabolic pathways mainly relies on the highly sensitive identification and quantitation of numerous metabolites and metabolic fluxes using metabolomics and isotope tracing analyses. However, nutritional requirements and metabolic routes used by cancer cells cultivated in vitro do not always reflect the metabolic demands of malignant cells within the tumor milieu. Therefore, to understand how the metabolism of tumor cells in its physiological environment differs from that of normal cells, these analyses must be performed in vivo. SCOPE OF REVIEW: This review covers the physiological impact of the exogenous administration of a stable isotope tracer into cancer animal models. We discuss specific aspects of in vivo isotope tracing protocols based on discrete bolus injections of a labeled metabolite: the tracer administration per se and the fasting period prior to it. In addition, we illustrate the complex physiological scenarios that arise when studying tumor metabolism - by isotopic labeling in animal models fed with a specific amino acid restricted diet. Finally, we provide strategies to minimize these limitations. MAJOR CONCLUSIONS: There is growing evidence that metabolic dependencies in cancers are influenced by tissue environment, cancer lineage, and genetic events. An increasing number of studies describe discrepancies in tumor metabolic dependencies when studied in in vitro settings or in vivo models, including cancer patients. Therefore, in-depth in vivo profiling of tumor metabolic routes within the appropriate pathophysiological environment will be key to identify relevant alterations that contribute to cancer onset and progression.

Extinction at the end-Cretaceous and the origin of modern Neotropical rainforests.

The end-Cretaceous event was catastrophic for terrestrial communities worldwide, yet its long-lasting effect on tropical forests remains largely unknown. We quantified plant extinction and ecological change in tropical forests resulting from the end-Cretaceous event using fossil pollen (>50,000 occurrences) and leaves (>6000 specimens) from localities in Colombia. Late Cretaceous (Maastrichtian) rainforests were characterized by an open canopy and diverse plant-insect interactions. Plant diversity declined by 45% at the Cretaceous-Paleogene boundary and did not recover for ~6 million years. Paleocene forests resembled modern Neotropical rainforests, with a closed canopy and multistratal structure dominated by angiosperms. The end-Cretaceous event triggered a long interval of low plant diversity in the Neotropics and the evolutionary assembly of today's most diverse terrestrial ecosystem.

GAPDH Expression Predicts the Response to R-CHOP, the Tumor Metabolic Status, and the Response of DLBCL Patients to Metabolic Inhibitors.

Diffuse large B cell lymphoma (DLBCL) is a heterogeneous disease treated with anti-CD20-based immuno-chemotherapy (R-CHOP). We identified that low levels of GAPDH predict a poor response to R-CHOP treatment. Importantly, we demonstrated that GAPDHlow lymphomas use OxPhos metabolism and rely on mTORC1 signaling and glutaminolysis. Consistently, disruptors of OxPhos metabolism (phenformin) or glutaminolysis (L-asparaginase) induce cytotoxic responses in GAPDHlow B cells and improve GAPDHlow B cell-lymphoma-bearing mice survival, while they are low or not efficient on GAPDHhigh B cell lymphomas. Ultimately, we selected four GAPDHlow DLBCL patients, who were refractory to all anti-CD20-based therapies, and targeted DLBCL metabolism using L-asparaginase (K), mTOR inhibitor (T), and metformin (M) (called KTM therapy). Three out of the four patients presented a complete response upon one cycle of KTM. These findings establish that the GAPDH expression level predicts DLBCL patients' response to R-CHOP treatment and their sensitivity to specific metabolic inhibitors.

Optimal positioning of self-expanding valves before deployment decreases paravalvular regurgitation following transcatheter aortic valve replacement.

OBJECTIVES: To evaluate the association between measurements performed during Medtronic CoreValve (MCV) deployment and paravalvular leak (PVL). BACKGROUND: The MCV can be recaptured and repositioned, allowing the TAVR operator to implant at a more favorable position. The association between angiographic measurements of MCV position while the valve is recapturable and PVL post deployment has not been investigated. METHODS: 493 patients undergoing TAVR with MCV (January 2011-July 2017) were included. PVL was defined as intraprocedural aortic regurgitation that was judged clinically to require balloon postdilation. Depth of the valve at the left coronary cusp (LCC) and noncoronary cusp (NCC) were measured when the valve was 80% deployed. An optimal cutoff value for the ratio LCC/NCC for PVL was identified in 40 patients. Using this cutoff value, the association between LCC/NCC and PVL was then validated in 453 patients. RESULTS: The median LCC/NCC was 1.51 (interquartile range 1.06-1.89).The optimal cutoff value for LCC/NCC was 1.48 (93% sensitivity, 77% specificity, AUC0.85). In the validation group 112 (24.7%) patients had PVL. For LCC/NCC ≥ 1.48, the incidence of PVL was lower compared to LCC/NCC < 1.48 (9.58% vs. 41.78%, P < 0.0001). LCC/NCC of 1.48 had a sensitivity of 79.5% and specificity of 63.6% for PVL (AUC0.72). In a multivariate model, LCC/NCC < 1.48 independently predicted PVL (OR = 6.67, 95% CI 3.96-11.23, P < 0.0001). CONCLUSION: Positioning the MCV such that the LCC/NCC is ≥1.48 may result in less PVL.

First uniportal video assisted thoracic surgery masterclass in Ecuador.

Currently video-assisted thoracic surgery (VATS) and the evolution Uniportal VATS have a worldwide acceptance and Ecuador is not exception when we decided invited to Dr. Diego Gonzalez-Rivas pioneer surgeon in the world of single-port video-assisted thoracoscopic procedures, with the aim to provide a faster recovery of the patients compared to those who received a conventional thoracotomy. We thanks the opportunity to present a report to the first Masterclass in Uniportal VATS with live surgery, performed on February 23rd to 24th of 2017 at the Luis Vernaza Hospital in Guayaquil-Ecuador. In addition to demonstrate the efficacy and safety of the uniportal VATS technique we presented a video of uniportal VATS left lower lobectomy performed by Dr. Diego Gonzalez-Rivas during the first uniportal masterclass in Guayaquil, Ecuador.

Transcatheter Aortic Valve Replacement for Perceval Sutureless Aortic Valve Failure.

As experience with Perceval aortic prosthesis and valve-in-valve TAVR grows, it will be crucial to meticulously document short- and long-term follow-up for establishment of real-world safety and durability of these new technologies.

Transcatheter Valve Replacement: Risk Levels and Contemporary Outcomes.

Transcatheter aortic valve replacement (TAVR) has exploded into medical care for aortic stenosis, thus changing the treatment options for patients. TAVR is currently approved for extreme-risk, high-risk, and intermediate-risk patients with symptomatic severe aortic stenosis, and randomized trials for low-risk patients are underway. This article traces the trajectory of TAVR as a viable option for higher-risk patients and examines current outcomes.

Vascular complication can be minimized with a balloon-expandable, re-collapsible sheath in TAVR with a self-expanding bioprosthesis.

OBJECTIVE: This study evaluates the feasibility and safety of a balloon-expandable, re-collapsible sheath for TAVR patients, including those with small iliofemoral access (≤5.0 mm). BACKGROUND: The recommended iliofemoral diameter for the CoreValve TAVR system is ≥6.0 mm, but the lowest limit has not been determined. METHODS: Of 322 consecutive patients who underwent TAVR from 1/2014 to 8/2015 at two institutions, 64 underwent transfemoral CoreValve implantation, using an 11/19-French balloon-expandable, re-collapsible sheath, which has a 4.45 mm outer diameter (OD) on arterial entry, expands to 7.67 mm, then re-collapses upon removal. Valve sizing and vascular access were determined by computed tomography, and outcomes were assessed using the Valve Academic Research Consortium 2 (VARC-2) definitions. RESULTS: Thirteen of 64 patients had a minimal iliofemoral artery luminal diameter (MLD) of ≤5.0 mm (mean 4.38+/-0.59 mm, range 3.1-5.0 mm), with vessel calcification ≤90° to 360° and tortuosity <45° to >90°. At the MLD point, the sheath-to-artery ratios, based on the fully expanded 7.67 mm OD, ranged 1.53-2.47, higher than previously reported ratios that risk vascular complications. Major comorbidities included chronic renal failure, severe chronic obstructive pulmonary disease, extreme thrombocytopenia, cirrhosis, prior cardiac surgery, poor ventricular function, and frailty. All 64 patients had TAVR with IV sedation and local anesthesia, with 0% sheath malfunction, 0% vascular complications, and 0% bleeding in-hospital and at 30 days per VARC-2 definitions. CONCLUSIONS: TAVR using a balloon-expandable, re-collapsible sheath is safe, including in small iliofemoral access ≤5.0 mm, thus considerably expanding the population suitable for transfemoral approach. © 2015 Wiley Periodicals, Inc.

Short-Term Outcomes with Direct Aortic Access for Transcatheter Aortic Valve Replacement.

BACKGROUND AND AIM OF THE STUDY: Transcatheter aortic valve replacement (TAVR) requires a safe route of access to the aortic valve. A direct aortic route has been used as alternate access approach in patients where ileo-femoral access is unsafe due to size, calcification and/or tortuosity. The study aim was to review the authors' results obtained with a direct aortic (DA) TAVR, examining in particular the safety and effectiveness of this approach. METHODS: A retrospective analysis was performed of all prospectively collected TAVR data from January 2011 to March 2015 at the authors' institution. DA-TAVRs were performed using either an upper mini- sternotomy (MST) into the second right intercostal space, or via a right anterior mini-thoracotomy (RAT) at the second intercostal space. The choice between MST and RAT approaches was made by the surgeon, based on aortic imaging, patent bypass grafts and pulmonary function. Both, Medtronic CoreValve and Edwards SAPIEN devices were used. All relevant perioperative and clinical outcomes were collected based on Valve Academic Research Consortium 2 (VARC-2) definitions. Median numerical values were used. RESULTS: Seventy-eight consecutive patients underwent DA-TAVR with 100% intraoperative survival and 92% 30-day survival. The procedural success was 97%. The majority of patients (79%) underwent DA-TAVR with the Medtronic CoreValve, via MST (92%). All patients were classified either as extreme (74%) or high risk (26%) for surgical aortic valve replacement. CONCLUSION: DA-TAVR provides a safe and viable alternate access approach for patients with inadequate ileo-femoral access. The clinical outcomes were acceptable in this very high-risk group of patients.

Pseudoaneurisma postraumático humeral / Post-traumatic humeral pseudoaneurysm

Las lesiones vasculares en las extremidades continúan siendo motivo frecuente de consulta en los servicios de urgencias. Errores en el diagnóstico y el manejo inadecuado contribuyen a consecuencias funestas como la pérdida de la vida o de la función de la extremidad. Las lesiones por arma blanca constituyen una de las principales causas con la aparición de complicaciones como son los pseudoaneurismas o falsos aneurismas. El objetivo de este trabajo es revelar la importancia del diagnóstico temprano de estas lesiones vasculares, que no son frecuentes, y del tratamiento quirúrgico oportuno para evitar complicaciones posteriores. Se trata de un paciente del sexo masculino, de 44 años de edad con antecedentes de herida por arma blanca en el tercio inferior del brazo izquierdo desde hace un año, el cual acudió a la consulta de angiología por presentar aumento de volumen en la cara interna del brazo acompañado de pulsaciones y latidos. Al examen físico se constató una masa pulsátil y expansible en la zona relacionada con el trauma y se auscultó un soplo holosistólico. El eco doppler color y la tomografía computarizada con uso de contraste mostraron la presencia de un hematoma pulsátil. Se realizó exploración quirúrgica a través de una incisión en la cara interna del brazo izquierdo a nivel del surco bicipital, evacuación del hematoma y la reparación arterial mediante arteriorrafia con sutura vascular no reabsorbible. La evolución posoperatoria fue satisfactoria con regresión de todos los signos clínicos(AU)

Vascular injuries in the extremities remain common and a frequent reason for going to the emergency services. Errors in diagnosis and inadequate management contribute to serious consequences such as loss of life or limb function. Stab injuries are a major cause in the development of complications such as pseudoaneurysms or false aneurysms. The objective of this paper was to show the importance of the early diagnosis of these vascular lesions that are not so frequent and the adequate surgical treatment to avoid further complications. This is a male 44 years-old patient, with a history of stab wound in the lower third of the left arm for one year, who went to the angiology service because of swelling in the inner arm accompanied by pulsations and beats. Physical examination found pulsatile and expandable mass in the trauma-related area and holosystolic murmur was heard. Color Doppler ultrasonography and contrasted tomography showed the presence of a pulsatile hematoma. Surgical exploration was performed through left arm inner part at bicipital sulcus, the hematoma was removed and arterial repair was made by vascular arteriorraphy with non-absorbable vascular suture. The postoperative course was satisfactory with regression of all the clinical signs